Active methodologies in medical education: between pedagogical innovation and the persistence of the lecture-based class.
Abstract
Active methodologies have gained considerable relevance over the past decade, and their incorporation into course syllabi has become mandatory. However, their implementation in the classroom does not always displace traditional lecture-based teaching, which continues to play an important role in the organization of learning. Objective. To describe the perception and experience of seventh-cycle undergraduate medical students regarding the use of active methodologies in the teaching-learning process. Method. An observational, descriptive, cross-sectional survey study was conducted in March 2026 among seventh-cycle medical students at the Catholic University of Cuenca, Ecuador. A census-based approach was used, and 104 valid questionnaires were analyzed. Data were collected through an online self-administered form that included sociodemographic questions, multiple-choice items, frequency scales, and Likert-type items aimed at exploring classroom experience, participation patterns, perceived barriers, and format preferences. Results. The lecture-based class was the predominant format during the previous academic cycle (54.8%) and was also the most valued format for addressing complex topics (47.1%). Nevertheless, students recognized relevant benefits of active methodologies: 84.6% considered that they help identify knowledge gaps, 64.4% stated that they promote clinical reasoning, and 78.8% positively valued the feedback received. The main barrier to participation was fear of making mistakes (53.8%). In addition, 78.8% reported having avoided speaking due to fear of making mistakes at least sometimes, and 76.9% reported either leaving class with unresolved doubts or perceiving the pace of the class as too fast. Conclusions. Students’ perceptions of active methodologies were nuanced and were not limited to absolute acceptance or rejection. The findings suggest the need for hybrid teaching sequences that integrate teacher-led exposition, guided activities, concrete feedback, and conditions of psychological safety that promote more authentic student participation.
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